This article discusses and presents options related to the cosmetic reduction of enlarged lips, primarily in ethnic populations. No formal study is performed. The author presents a literature review and discusses his personal 26-year experiences in lip surgery. When basic tenets are followed, cosmetic lip reduction is a predictable procedure with very little morbidity. Although lip augmentation is a popular cosmetic procedure, a certain percentage of the population desires smaller lips. Reduction cheiloplasty is a safe and predictable procedure that has been performed over a half century. This procedure is relatively simple and has a moderate learning curve. Cosmetic lip reduction is safe and effective, and has a high level of patient acceptance when certain diagnostic and treatment criteria are fulfilled.